The present invention relates generally to instrumentation, kits and methods for reconstruction of soft tissue, including soft tissue such as tendons and ligaments, and particularly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in the knee joint.
ACL injuries are often caused by a sudden force applied to the knee, and are a common form of injury in athletic activities. The injury occurs typically when the knee is bent or twisted in an awkward direction.
Current surgical reconstruction of ACL injuries may be arthroscopic or open and commonly include the formation of two bone tunnels, one in the tibia and one in the femur, which serve as attachment points for a soft tissue graft. Procedures for formation of the bone tunnels typically fall into two main categories. The first commonly uses a “trans-tibial” procedure in which a linear offset guide is placed through a tunnel drilled in the tibia. The offset guide positions a rigid guide pin, also positioned through the tibial tunnel, towards the femur to form the femoral tunnel. However, this procedure often does not allow the surgeon to position the guide pin at the correct anatomical site of the native ACL (the native ACL attachment point) on the femur. As a result, the rotational stability of the ACL replacement graft is reduced.
The second type of common surgical reconstruction uses an “anterior-medial portal” procedure in which a similar offset guide is placed through a skin incision and into the joint. Since the guide is not within the tibial tunnel in this approach, the guide is less stable but has the freedom to be placed anywhere along the femoral notch, though accessing the native ACL attachment point with the rigid guide pin is normally not possible without hyperflexion of the knee. Thus, without hyperflexion of the knee during rigid pin placement, the length of the femoral tunnel could be shorter than usually desired in addition to other pitfalls such as pin proximity to, for example, the peroneal nerve and the femoral insertion point of the Lateral Collateral Ligament. However, hyperflexion has various drawbacks: the surgeon loses the visual reference to anatomic landmarks that are usually seen at a normal, ninety degree, flexion, and hyperflexion is difficult to do when using a leg holder, which is typically used in all repair/reconstruction procedures, or may be impossible due to a patient's build or anatomy. The surgeon can compromise tunnel integrity and thus fixation strength if the joint is not hyperflexed properly. However, if done properly, the native ACL attachment point may be accessed in order to position the ACL graft at or near this native point.
During such arthroscopic surgical procedures, particularly on a joint, such as a knee, a surgeon will force a clear liquid, such as saline or Ringer solution, into the joint to provide better viewing potential through an arthroscopic camera. The clear liquid forces blood and other fluids, suspended solids and debris from the joint. In order to maintain the joint volume free of these other substances, the clear liquid must be maintained at an elevated pressure, otherwise viewing ability is lost.
Typically in arthroscopic procedures, a surgeon will use a cannula, or the like, which provides an entryway for surgical tools into the joint, as well as, detrimentally, an exit for the clear liquid from the joint. Furthermore, cannulated guide tools may be passed into the joint via a cannula or directly through surgical incisions without a cannula. Such cannulated tools also provide a conduit for the clear liquid to exit the joint. When such instruments are used, the surgeon must increase the flow of clear fluid into the joint, using a fluid pump for example, to maintain the required elevated pressure. And in some instances, such a large amount of clear fluid is lost through the cannula or cannulated guide tool that maintaining the elevated pressure is not feasible. Moreover, the clear fluid may exit onto the surgeon's hands and even the floor, leading to dangerous safety conditions such as a slippery floor where the surgeon is working.
Thus, there is a need in ligament and tendon repair or reconstruction surgery for instrumentation and procedures which may be used, for example, for ACL surgery with the knee at various normal degrees of flexion, including ninety degree flexion and even at hyperflexion, if needed, which may be capable of aligning the drill pin to contact the femur at the native ACL attachment site, which may be simple and replicable, which may be used in arthroscopic procedures in which a clear liquid is used within the surgical space, and which has other benefits over the existing instrumentation and procedures.